Healthcare Provider Details

I. General information

NPI: 1447614185
Provider Name (Legal Business Name): TAWNY NESMITH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12741 TANADA LOOP
ANCHORAGE AK
99515-3825
US

IV. Provider business mailing address

12741 TANADA LOOP
ANCHORAGE AK
99515-3825
US

V. Phone/Fax

Practice location:
  • Phone: 913-309-7973
  • Fax:
Mailing address:
  • Phone: 913-309-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number135737
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2017029118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: